14* T O,,,@ .AijIT TkT -@AC@-LiTIES A;"i) T'@ HILL-6uRTOi\,, a- iV]DiEi@TS o-@ -Ii. Cronin, D., A.P.A.1 T Chief . @Division of iospital ,Facilities De,,artm,erit,, of 'Heal- 4., ',a r , @ducation, and -,,4elfare The i-kdical Facilities .survey and Construction Act of 1954 broadened the :10spital ilarvey ard Construction Fror-.ram to include and emphasize facilities for providin- services +.or the c,!-zonic ill and impaired. These amendments authorize an appropriation of two million dollars for grants to the States, on a dollar for dollar mELtcliin6, basis, to survey the need for and to develop State plans to meet the need for chronic disease facilities nursing homes, diagnostic or diag- nostic and treatment centers, and for rehabilitation 'abilities. This survey and plannini.- money remains available unti'A. experded. Tile minimum allotment for s-@,rey ard plains-, purposes to any of ttie O'tates is -'25,000. The maximum allot- ment to a @'tate is controlled b,7 the population of the 6tate. .Lin additional authorization of 60 million dollars annually to assist in pa@.m,:- part of t'ne cost of construction of these facilities earmarks 10 million dollars each for nursing home and rehabilitation facilities, and, 20 million dollars each for c.=onic disease facilities and diagnostic or diagnostic and treatment centers. These appropriations are authorized for the fiscal years 1955, 1956, and 1957. This coincides with the present statutory time l@ta on of the T.;-Ospital Survey and ',onstruction Pro@ram. Tiie 60 million dollar author- ization is in addition to the annual authorization of 150 million dollars contained in the basic law. The. modus operandi of the broadened program is essentially the mm as the original program with the initiative for acquiring facilities and the oper*. ation of the completed facilities restinr, with the local community. The State -t'Tesented - A.,merican @li-c ',Iealth Association, 82nd Innual i.'@etin-- @iemo.-ial Auditorium, @falo, \,ew for'.-., October 13, 1954. and --ederal Gover-me,.its act in cooperation with t.-,e sponsors of' tire projects to .i eii-a'.)le them to construct tie Facilities of the type needed ar@d placed where the need is t@:-,e reatest wit,@ii-n tire ;tate. T.@e pro-ect application -f'or construction --e O..-' -n ac--or@@.ance Lyle @@te -,'@ans, are t'i -ederal and tate a:-enc4as ad ' ister-r.:; the promTam. Jack .state eter- .@e . - - min mines the amount o.-L@ 'ederal participation !-'or each project. '-nederal matcnini, 2unds will be a -ninim= of 33-'LI3 and a m-ax.i-,n-,,,,i o-i-' c6-2/3 @ercent of t,.ie cost of construct4@n;,- and equipping ol' each dej.'ined pro-ect defending on one o.-L" several options the itate a-@enc,@f Ma@r C'.10OSe. In eneral, the new amendments are ar- inducement to itates and local communities to provide tie facilities -f'or the care of the chronic i22 @ impaired which are greatly needed and @or which tlere will be an ever-increasing demand due essential'L,,r to the characteristics of our total population and the controlli@-- elements o.Ln good medical care. ,,Rehabilitation facilities were el4-@,,ible under t.,ie existing Hospital Sjrvey and Construction Pro am if they were part o@' a hospital. T-',,,e new amendments authorize, in addition, assistance for the construction of rehabilitation facilities when not of a hospital. The annual appropriation of 10 million dollars for rehabilitation facilities authorized by the 1954 amendments will be allotted to the States on the basis of the existing statutory formula, the controlling factors of whicii are the State's population and per capita income. T,.ie minimiin allotment to any I;tate -s 50,,OOO for rehabilitation facilities. Two or ,nore States may pool r - t-ion faci I @lederal grants @o construction of a rehabil;ta4l lity. 'funds allotted for rehabilitation facilities may be used for no other purpose. This feature is different from the funds allotted for chronic disease hospitals, nursing aomes, and diagnostic or diagnostic and treatment centers which my =der certain eir- cumstances be transferred from one category to another, Tne foregoing is a recital of the salient features of the @iedical Facilities Survey and Construction Act of 1954, Public Law 4b2, 83rd ConCress. 3 @7t is most fittin- to consider the implications in the @ct in rera d to - r L> rehabilitation facilities and pro@rams. T@tle 'A-ct has important implications for 4-nLter-prof-'es,:;-onal Collaboration and Performance (2) communit7 nealti.,L plan,.ii@r.6; a-"d k'3)' @'or -ieath promotion and c.@-onic disease control. T";Ie term rehabilitation facility is defined in the Act.as "a facility which is operated for the primary purpose of assisting in the rehabilitation of disa-L;led persons throuE:h an integrated proeram of ,nedical, psyc'--.oloi;ical, social, and vocational evaluation and services under competent professional supervision, a.-id in the case o.L' whi@i the major portion of such evaluation and services is furnished within the @acility; and either (A) the facility is operated in connection with a hospital, or (B) all medical and related health services are prescribed b, or are under the -,eneral@ direction of persons licensed to practice medicine or s-ar,,-er@,, n t!,ie @@tate". The reference to @Liite.-rat4-on in the definition -Ls recognition o-' a basic Pr,-nc--Ple o.@ rehabilitation - t'Lie 1-ndispensabilit,,r of effective inter-professional cooperative effort L'or the rehabilitation process. A@eazwork is not a new concept or activity eitlier@in clinical medicine or in public health. Teamwor'.c in rehabilitation whether directed toward helping a severely @ndicapped individual to live and work with what he has, or toward developing a coordinated.com=mity program of rehabilitation services is exceptionally complex and often.difa'icu Even thoigh the goal of the rehabilitation process may be specili-callj- defined the very nature of the problem requires that tre goal be sought througtL profes- sional services and skil Is that varjr widely in a'-,iaracter and methods. ivbmbers Of the "rehabilitation team!' come from professions and skills that are in different stages of development and refinement, and, vary -reatly in prestice @tus accorded by our cult=e. Even technical vocabulary developed and used in each professional -field or skill complicates effective cooperation and under- stand,'_n,-, by comunication slow and difficult. The essentiality of 4 bringing to the person with disability all o@ the services needed to restore Jim to complete or @rtial@ independence forced and demanded recognition of the inter- @ro,L,es,siona.L are 1-@,ar-sk4 !Is Cooperative @.njeavor as a must. '@n the t4-cn process. osliat needs to be faced directly and objectively is the Meaning of the tL team approach and Lie most effective ways of securin,-, inter-professional and inter-sk4-l.ls cooperation. It -is absolutel@- necessary for the re-'-abilitant and I ask who else matters if we are to do our job. T .&n -modern medicine, fro,-. the expansion of scientific cnowled;)-e and the inereasin-- complex,-ties of diagnostic aids, a.-Id therapeutic and supporting services, as well as from the social changes res,,iltin6 from t@.ie trend toward an industrial, urban life we L'ind the phenomenon of -specialization. 'iiit'.'l medical specialization has come increased l@'ocus upon the need to consider the "latie,-it Current trends in medical education are toward a better under- as a w.,iolen4 standing of the appropriate balance of physical, mental, emotional and social factors in illness and disability. Moreover, general skills in medicine are bei% identified as including skills in teamwork and in use of consultants. The need for the development of specific training for cooperative work with colleagues is increasingly regarded as essential.. There is still much to be done on identif5rin- leadership and participating roles in the medical team as well as on methods of synthesizing the contributions of adjunctive services. There is need for definitive analysis of problems,.practice and ways 'TIO achieve successful inter- ofessional functioning. Chief among ti'-iese are the Pr nature of team leadership,, ways oil coordinating services to a given individual or in program planning and when, how, and to whom responsibility for the @'%Oient's rehabilitation pro;,!ram should be shifted and to w@at degree as qis needs change. i'-.any health problems in the past have been solved through joint planning between health -roups, community jroups, and voluntary iealth agencies. The Hospital -Durvey and Construction Pro,@ram is just such a cooperative endeavor. 'Lts 230%ld appro-.red projects representi@:r over 109,000 liosp@l beds, @3 public health centers and ;Mary adjunctive service facilities nearlj 1 billion &50 million dollars, of wnich bl@ @illion dollars 4.3 -7eieral =oney and 1 billion 232 @l"! 4-on -@s '--tate and local -",@ds demonstrates w.@@iat --ar, ;,,P, achieved 4-n less than nine years. In developing a pro.@am for rehabilitation facilities a fact-finding job is essential to defi,-un.@ t'.ie needs of communities for such facilities. 'L@ie new amendments provide for a survey by tire @tates of existin,, facilities in the 2,.eld of r6iiabilitation as a prerequisite to developing a plan to meet t,lese needs. Generally speaki@-, the chain of rehabilitation services offered in general hospitals, in special hospitals, or in hi@,hly developed rehabilitation facilities for the treatment of severe Impairments is no stronger tmn its weakest link. Often the weakest link is the availability and accessibility of resources in the reiiai;i-l,--tar@tts @toae coin,.iiinity. .T. .Ln manj instances rehabilitation efforts succeed or -:'ail because tile nature and quality of the continuin,,- services available in ti-le patievit s ho,!le community during that all important period following dischar;-e from the hospital or rehabilitation facility are unrealistic in terms of community employment opportunities. Furthermore, if needed medical or nursing supervision cannot be continued in the patient's communit,,,,, if qome pressures or unhappy familyr relation- ships precipitate another breakdown, if vocational tra4Lninr, is not followed by help in securing employment, the gains made in a special rehabilitation setting will have been lost and the patient's confidence undermined. T.io comprehensive rehabilitation facility with its wide range of services although specifically authorized by t.,ie new amendments are not tire only needs in this field. All communities need to make provision for services to the physically and mentally @ired persons for rehabilitative services which they can feas'6bly support and which are adapted to t',Ieir needs and resources. T.iese services are a part of the nealth mi-,itenance prorram of any community. much community renabl-l'itation projec4,s niSht -,@row oLxt of or be centered .L LI in a hospital re.,iabil-Ltation program; they mi-ht be part oL' a b:@-cad chronic disease control plan, or, they mi@ht be sponsored by social a-enc@es, workmen's compensation a--er@---'@es, or a combination of agencies Interested problems o'L tire disabled. Tiis plea is for a cooperative and coordinated endeavor at all times. be impose upon any Experience iias A.-.-,d--cated that no "blue print" can co, it-,,. T'.-.e variables in stage of development, existing health, welfare, educat-.o-@i and employment resources and recognition of need for services are numerous. in many communities, however these programs are t-',le focal point for case-finding, evaluation and re.L'erral. ;'or here, altiough the serv-,ces may be limited t'.je problem is -denti-'ied and the approoriate resource in the lar--er urban center so@'it. '7urti.lermore complex disabilities my be referred to facilities with t!Lie esse-i-it:-.al- elements of a comprehensive rehabilitation pror,,ram. These are but a few of the implications for community plannina. Co.=tLnitir planning of the hi@hest order needs to be attained if t-ie comorenensive re'LAbil- itation facilities intended by the @et are to meet t:ie needs existent today. bot every community will be planning a comprehensive rehabilitation facility. ibLny communities will be needing help in understanding the nature and extent of the problem. Greater progress can be made if tile community is left free to determine its own met.,iod of solving its problem. 'Lhe survey monerf., if well used., should aid tAese communities in solvi@i-- the basic problem of careful planning and pooli.% of resources in order to avoid costly duplication of facilities as well as filling in ,Yaps i,.i needed services for disabled persons. Advances in medicine @ the application of public health measures lave been influential in permitting more of us to reach the ages of senior citizens. vwe still @.K -aeasures to prevent or cure many chronic diseases which partially or totallr disable. result has been a need for providing disabled persons 7 with ielp in learnin.-- to live and work with wriat tiey have left competently and graciously. Here must -uard aaa'-nst iman's reaction to his own disabilities in an adverse Tanner emotiorall--.,. Unti'L medical research discovers ti-,e cure for and of preventing .-esi,.4ual disability for such conditions as poliomyelitis, multiple sclerosis, diseases of the heart and blood vessels, arthritis, to name but a few of the many incapacitating i3.lnesses.. representatives of the -health professions must depend upo n and utilize the teciir-.iqi:.es of medical specialists, Psychological and social services, education, vocational training, placement, and selective lob placement in helping disabled persons to attain their full potentialities for useful and satisfying lives. Comunity-wide planning for care and treatment of t,-ie chronically ill is still in the embryonic stage. i,(iore attention will need to be given to the application of rehabilitation techniques for chronic disease control in order to avoid human and economic waste. 'in no other a.-ea of activity is there a greater challenge to the health professions for devising new ,aethods for Iro control of c.,=onic disease and for health promotion and health maintenance. keep a disabled person functioning at a desirable level of efficiency implies -,ram of health maintenance and health promotion. T-ie develop- a continu.,:n,, proL ment of adequate rehabilitation facilities and services bec=es,. therefore essential, along with prevention, diagnosis, and treatment. In fact, just as it has become difficult to draw a hard and fast line between preventive and curative services so too it is becoming difficult to separate clearly curative and rehabilitative services. @-t is =1 opinion we should not try to do so as these elements of medical care are insepara'ole in the over-all proi-;ram of health maintenance for the individual. Tiie modern health facilities including rehabilitation facilities have exteriors w ,,ave "eye-appeal". Ti-ieir lzteriors are clean-cut, attractive, di-nifi-6d and well-balanced, The4-r desi-n follows the architectural axiom t'@t form follows function. A word picture of the health program to be carried cn in aci-isy 7aae --Y -,re --ar7.OUS .,.-3a.L. sl r@4ng @oint f,)- a '.i Professionals -'-z ,a the architect. His creative ability and ingenuity will float wastefully unharnessed and to a great extent powerless without that program descript on. Again, I must emphasize that the beauty and grace, the implied usefulness and inherent potential for good of the functionally designed health facility, by and of itself, is but the instrument of man and the vehicle by which health services reach those in need through program of service and lives of devotion. Finally, all these plans, methods of and for rehabilitation facilities and programs are but idyllic dreams w'4thout that priceless ingredient - the trained and experienced worker. I trust and hope that we will utilize the opportunities provided in the new amendments relating to rehabilitation facilities to develop and train rehabilitation workers. If we do we may soften somewhat man's i.-ihuranities to man. I would like to.